<%
//下载APP
layout("/inc/layout.html",{
title:'残联基本信息 - 残联申请 - 智慧洛龙',
keywords:'残联基本信息,残联申请,智慧洛龙',
description:'残联基本信息,残联申请,智慧洛龙',
style:'index.css'
}){
%>
<section class="container">
	<div class="row mt15 text-left">  
	    <ul class="breadcrumb">
	    	<li>当前位置：</li>
			<li><a href="/">主页</a></li>
	        <li><a href="/list/1">个人办事</a></li>
	        <li>残联申请</li>
	    </ul>
    </div>
</section>

<section class="container">
	<div class="row">
		<div class="panel panel-info">
			<div class="panel-heading text-left">
				<ul class="nav nav-tabs">
					<li class="active"><a href="/disabilityApply/base"><b>残联申请</b></a></li>
					<li><a href="/disabilityChange/base"><b>残联变更</b></a></li>
					<li><a href="/disabilityReapply/reapply"><b>残联补办</b></a></li>
					<li><a href="/disabilityCancel/cancel"><b>残联注销</b></a></li>
				</ul>
			</div>
			<div class="panel-body">
				<legend>
					<span class="text text-danger" id="messageCode">个人信息</span>
				</legend>
				<form id="disabilityInfo" class="form-horizontal">
					<input type="hidden" name="id" id="id" value="${id!''} ">
					<input type="hidden" name="userPhoto"  value="${apply.userPhoto!}">
					<div class="col-sm-offset-2 col-md-6"> 
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">姓名</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入姓名" name="name" value="${apply.name!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">性别</label>
						    <div class="col-sm-10">
						    	<input type="radio" value="1" name="sex"  ${apply.sex==1? "checked"} ${apply.sex==null? "checked"}>&nbsp;<font style="font-weight: bolder;">男</font>&nbsp;
                                <input type="radio" value="2" name="sex"  ${apply.sex==2? "checked"} >&nbsp;<font style="font-weight: bolder;">女</font>&nbsp;
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">民族</label>
						    <div class="col-sm-10">
					      		<select class="form-control"  name="nation">
					      		<option value="">请选择民族</option>
					      		<%for(nation in nationMap){%>
									<option value="${nation.key}" ${apply.nation==nation.key? "selected"} >${nation.value}</option>
							      <%}%>		
								</select>
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">户口类别</label>
						    <div class="col-sm-10">
							 <input type="radio" value="1" name="residenceType" ${apply.residenceType==1? "checked"} ${apply.residenceType==null? "checked"}>&nbsp;<font style="font-weight: bolder;">城镇户口</font>&nbsp;
                             <input type="radio" value="2" name="residenceType" ${apply.residenceType==2? "checked"} >&nbsp;<font style="font-weight: bolder;">农业户口</font>&nbsp;
                             <input type="radio" value="3" name="residenceType" ${apply.residenceType==3? "checked"}>&nbsp;<font style="font-weight: bolder;">其他户口</font>&nbsp;
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">婚否</label>
						    <div class="col-sm-10">
							<input type="radio" value="1" name="married" ${apply.married==1? "checked"} ${apply.married==null? "checked"}>&nbsp;<font style="font-weight: bolder;">未婚</font>&nbsp;
                             <input type="radio" value="2" name="married" ${apply.married==2? "checked"} >&nbsp;<font style="font-weight: bolder;">已婚</font>&nbsp;
                         
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">籍贯</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入籍贯" name="originPlace" value="${apply.originPlace!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">文化程度</label>
						    <div class="col-sm-10">
						    <select class="form-control"  name="culture">
						            <option value="">请选择文化程度</option>
									<option value="文盲" ${apply.culture=="文盲"? "selected"} >文盲</option>
									<option value="小学" ${apply.culture=="小学"? "selected"} >小学</option>
									<option value="初中" ${apply.culture=="初中"? "selected"} >初中</option>
									<option value="高中" ${apply.culture=="高中"? "selected"} >高中</option>
									<option value="专科" ${apply.culture=="专科"? "selected"} >专科</option>
									<option value="本科" ${apply.culture=="本科"? "selected"} >本科</option>
									<option value="硕士" ${apply.culture=="硕士"? "selected"} >硕士</option>
									<option value="博士" ${apply.culture=="博士"? "selected"} >博士</option>
								</select>
						    </div>
				  		</div>
					</div>
					<div class="col-md-4">
						<div style="width: 230px;height: 220px;">
				      		<img id="photo" src="${apply.userPhoto!'/images/user/user.jpg'}" alt="你的照片" style="width:100%;height:100%">
					    </div> 
				  		<button type="button" class="btn btn-primary" data-toggle="modal" data-target="#uploadModal" style="width: 230px;margin-top: 20px;">
						  上传照片
						</button>
					</div>
					<div class="col-sm-offset-2 col-md-6">   
						<div class="form-group">
						    <label class="col-sm-2 control-label">出生日期</label>
						    <div class="col-sm-10">
					      		<input type="date" class="form-control" placeholder="请输入出生日期,例如：1990-01-1" name="birthday" value="${apply.birthday!,dateFormat="yyyy-MM-dd"}">
						    </div>
				  		</div>
						<div class="form-group">
						    <label class="col-sm-2 control-label">身份证号</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入身份证号" name="cardNumber" value="${apply.cardNumber!}">
						    </div>
						</div>
						<div class="form-group">
						    <label class="col-sm-2 control-label">现住址</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入现住址" name="address" value="${apply.address!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">联系电话</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入联系电话" name="mobile" value="${apply.mobile!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">邮编</label>
						    <div class="col-sm-10">
					      		<input type="text" class="form-control" placeholder="请输入邮编" name="postcode" value="${apply.postcode!}">
						    </div>
				  		</div>
					</div>
				</form>
			</div>
			<div class="panel-footer">
      			   <div class="col-sm-offset-3 clearfix">
                    <div class="mt5 mb5 block col-sm-3">
                        <a href="/user/transact" class="btn btn-warning btn-lg btn-outline btn-block">我的办件</a>
                    </div>
                    <div class="mt5 mb5 block col-sm-3">
                        <button type="button" id="doSubmit" class="btn btn-danger btn-lg btn-outline btn-block">下一步</button>
                    </div>
                </div>
			</div>
		</div>
	</div>
</section>
<!-- 上传dialog -->
<div class="modal fade" id="uploadModal" tabindex="-1" role="dialog" >
  <div class="modal-dialog" role="document">
    <div class="modal-content">
      <div class="modal-header">
		  <h5 class="modal-title" id="uploadModalLabel">上传照片
		      <button type="button" class="close" data-dismiss="modal" aria-label="Close">
		      	<span aria-hidden="true">&times;</span>
		      </button>
		  </h5>
      </div>
      <div class="modal-body">
	      <form enctype="multipart/form-data">
	      	<input id="userImg"  name="files" type="file" >
	      </form>
      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-secondary" data-dismiss="modal">关闭</button>
      </div>
    </div>
  </div>
</div>

<% } %>
<script>
    require(['modules/disability_apply'], function (apply) {
        apply.index();
      
    });
    
</script>
</body>
</html>